Active NPI
Meryl Pankhurst, PSY.D.
- Clinical Psychologist
- Northfield, IL
National Provider Identifier
1407288079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071004395
- Practice address
- 465 N Central Ave
Suite 201
Northfield, IL 60093-3015 - Phone
- (847) 686-0090
- Fax
- (847) 686-0090
- NPI assigned
- Aug 6, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071004395 | IL | Primary |
Addresses
Primary practice location
465 N Central Ave
Suite 201
Northfield, IL 60093-3015
Mailing address
465 N Central Ave
Suite 201
Northfield, IL 60093-3015
Phone (847) 686-0090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
160 E Grand Ave
Suite 500
Chicago, IL 60611-3800
Phone (847) 686-0090
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Primary Care Psychology Associates
- Clinical Psychologist
- Chicago, IL
- NPI 1497428817
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1407288079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "465 N CENTRAL AVE",
"address_2": "SUITE 201",
"city": "NORTHFIELD",
"state": "IL",
"postal_code": "600933015",
"telephone_number": "847-686-0090",
"fax_number": "847-686-0090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 N CENTRAL AVE",
"address_2": "SUITE 201",
"city": "NORTHFIELD",
"state": "IL",
"postal_code": "600933015",
"telephone_number": "847-686-0090",
"fax_number": "847-686-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANKHURST",
"first_name": "MERYL",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-06",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071004395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.